Bronchopulmonary dysplasia (BPD) occurs in approximately 40% of infants born at younger than 30 weeks gestation and is associated with adverse pulmonary and neurodevelopmental outcomes.A new study published in JAMA Pediatrics tested whether the administration of inhaled nitric oxide to preterm infants, requiring positive pressure respiratory support on postnatal days 5 to 14, improves the rate of survival without BPD.This randomized clinical trial was performed at 33 US and Canadian neonatal intensive care units, including 451 neonates younger than 30 weeks gestation with birth weight less than 1250 g receiving mechanical ventilation or positive pressure respiratory support on postnatal days, 5-14. Placebo (nitrogen) or inhaled nitric oxide initiated at 20 ppm was decreased to 10 ppm between 72 and 96 hours after the initiation of treatment, and then to 5 ppm on day 10 or 11. Infants remained on the 5-ppm dose until the completion of therapy (24 days).Overall, 222 infants received placebo, while 229 infants received inhaled nitric oxide. Their mean gestations were 25.6 and 25.6 weeks, respectively and their mean birth weights were 750 and 724 gm, respectively. Survival without BPD at 36 weeks postmenstrual age (PMA) was similar between the placebo and inhaled nitric oxide groups; and postnatal corticosteroid use for BPD and the mean days of positive pressure respiratory support and hospitalization were equivalent between the two groups. In addition, no differences in the incidence of common morbidities were observed. Furthermore, respiratory outcomes on discharge, at 1-year, and at age 18 to 24 months PMA and neurodevelopmental assessments at 18 to 24 months PMA did not differ between groups.Hence, it was inferred that inhaled nitric oxide, initiated at 20 ppm on postnatal days 5 to 14 to high-risk preterm infants and continued for 24 days, is safe, but did not improve survival without BPD at 36 weeks PMA nor the respiratory and neurodevelopmental outcomes at 18 to 24 months PMA.